DRG Clinical Validation Auditor - RN (CDI, MS-DRG, AP-DRG & APR-DRG)

IntelliResume; Indiana (PA); On-site; USD 87,000 - 156,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

401k contribution

Job summary

IntelliResume is seeking a DRG Clinical Validation Auditor - RN to audit inpatient medical records to ensure clinical documentation accuracy. This role is ideal for professionals with claims auditing expertise, ensuring medical records support the billed conditions and DRGs.

With comprehensive benefits and a commitment to simplicity in healthcare, IntelliResume offers a position well-suited for those with over 10 years of experience in the field, including knowledge of coding principles and

Qualifications

• Current, active, unrestricted Registered Nurse license in applicable state(s).
• Minimum of 10 years in claims auditing, quality assurance, or clinical documentation improvement.
• Minimum of 5 years working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.

Responsibilities

• Audit inpatient medical records for clinical documentation accuracy.
• Analyze and audit claims using medical chart coding principles.
• Maintain accuracy and quality standards as established by audit management.
• Identify potential documentation and coding errors.
• Suggest and develop process improvement recommendations.

Skills

Claims auditing

Clinical documentation improvement

ICD-9/10CM

Audit tools utilization

Education

Current RN license

Job description

About This Role

The DRG Clinical Validation Auditor - RN is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. This role is ideal for experienced professionals with expertise in claims auditing and clinical documentation improvement.

Highlights

• Pay: $86,560 - $155,808/year
• Location: Indianapolis, IN

What You'll Do

• Audit inpatient medical records for clinical documentation accuracy.
• Analyze and audit claims using medical chart coding principles.
• Utilize audit tools and workflow systems to generate audit determinations.
• Maintain accuracy and quality standards as established by audit management.
• Identify potential documentation and coding errors.
• Suggest and develop process improvement recommendations.

Requirements

Education:

• Current, active, unrestricted Registered Nurse license in applicable state(s).

Experience:

• Minimum of 10 years in claims auditing, quality assurance, or clinical documentation improvement.
• Minimum of 5 years working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG.

Licenses & Certifications:

• Current RN License in applicable state(s).
• Preferred certifications: RHIT, RHIA, CCDS, CDIP, CPC, CCS, or CIC.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution

About Elevance Health Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. They are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels who are passionate about making an impact on their members and the communities they serve.